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Name of Child:
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
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Indiana
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Kentucky
Louisiana
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Maryland
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New Hampshire
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New Mexico
New York
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North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Contact Phone Number:
*
Please enter a valid phone number.
Email Address:
*
example@example.com
Number in Household:
*
Median Annual Household Income
*
Age:
*
Birthdate:
*
-
Month
-
Day
Year
Grade Completed as of May 2023:
*
Name of Current School:
*
Guardian Name:
*
First Name
Last Name
Guardian Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Guardian Email Address:
*
example@example.com
Guardian Phone Number:
*
Please enter a valid phone number.
Please list child's relevant medical history and any allergies:
Faith-Based Camp Preferences:
*
No, I prefer non faith based camps.
Yes, I prefer faith or religious based camps.
I'm interested in all camps!
Have you attended camp before?
*
Please Select
Yes
No
If you answered yes, please list the camp name(s) along with year(s) attended:
Have you received this scholarship before?
*
Please Select
Yes
No
Please list any other scholarships (if any) you have applied for to assist with camp this year:
If there is a specific camp you are hoping to attend, please list:
If there is a specific date or time frame you would prefer to attend, please list:
OPEN RESPONSE PORTION
Please finish the following statement with your child. Feel free to attach a response separately if additional space is needed.
"My dream day at camp would include..."
No more than 250 words please.
0/250
Attached essay question or any other relevant documents:
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